Tweede herziene consensus melanoom van de huid

B.B.R. Kroon, W. Bergman, J.W.W. Coebergh en D.J. Ruiter

Second revised consensus on melanoma of the skin

– The ‘Guideline melanoma of the skin, second revised consensus’ was published in March 1997. Some of the contents are cited:

– Over 1600 new melanomas are diagnosed in the Netherlands each year; by now the mean 5-year survival amounts to over 80.

– In examination of a pigmented lesion a dermatoscope is a valuable tool.

– The recommended margin of the diagnostic excision was reduced from 5 mm to 2 mm of macroscopically normal skin round the lesion; the margins in definite excision are: 1 cm of normal skin for a Breslow thickness ≤ 2 mm; 2 cm for a Breslow thickness > 2 and ≤ 4 mm. A margin of at least 2 cm seems also justified for thicker melanomas.

– Elective (prophylactic) regional lymph node dissection is advised against. Sentinel node biopsy appears to be an attractive method to detect occult metastasis in regional nodes. In lymph node metastasis a (therapeutic) regional lymph node dissection should be performed.

– In case of inoperable tumourgrowth in an extremity regional isolated perfusion is indicated.

– Radiotherapy may be applied curatively (e.g. if surgery is not possible), palliatively (if desired in combination with hyperthermia) or postoperatively (if non-radical resection is suspected).

– Adjuvant systemic therapy in melanoma patients is still experimental; the earliest results of high doses of interferon alpha are encouraging.

– Atypical (dysplastic) naevi and congenital naevi are important risk factors for melanoma. No consensus was reached regarding prophylactic removal of all congenital naevi.

– Regarding the duration of the follow-up period, 5 years suffices in patients with a melanoma with a Breslow thickness ≤ 1.5 mm (provided there are no histological signs of regression), while 10 years is required for melanomas with a Breslow thickness > 1.5 mm. The patient should be actively involved in the follow-up (inspection, palpation). Routine blood testing, roentgen examination or ultrasonography are considered to be useless.

– There are no indications that hormonal alterations during pregnancy or use of the pill stimulate the growth of micrometastases that may be present.

– Excessive exposure to ultraviolet rays is discouraged.